Evaluation Questionnaire (Attach 9)

The NIH-AARP interactive Comprehensive Lifestyle Interview by Computer Study (iCLIC) (NCI)

Documents and Forms

Document Name Document Type
Form 9 Evaluation Questionnaire (Attach 9) Form and Instruction
9 Evaluation Att 9_EvaluationQuestionnaire.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Evaluation Questionnaire (Attach 9)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	9	Evaluation	Att 9_EvaluationQuestionnaire.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,288	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2,288	-1,348	3,636
Annual IC Time Burden (Hours)	38	-23	61
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.